Back To School Struggles

Back to School Struggles: How Do I Know if My Child Has AD/HD?

Now that summer is over, some of the struggles that your child may have experienced last school year may return. It is not unusual for children with learning and attention disorders to have conflict free summers and holidays, only to have their behavior deteriorate once school resumes. In our practice, we observe a spike in school refusal at the beginning of the school year, followed by problems with completing assignments and disruptive classroom behavior. Such problems can be especially intense when a child attends a new school following a move or when entering the next level of schooling. The three Ds are common: distractibility, disorganization and defiance. Perhaps your child has AD/HD: but how is a parent to know?

Some people believe that AD/HD is overdiagnosed. For example, the New York Times published an article titled “The Selling of Attention Deficit Disorder” in December, 2013 in which it claimed that “1 in 7 children” receive the diagnosis before age 18. Recent data from the Centers for Disease Control and Prevention (CDC) indicates that in 2007 the national incidence of AD/HD was 9.5%/ By 2011, it had grown to 11%, which is equivalent to 1 in 9 children. But one has to examine the CDC data to learn more about how many children are actually being treated for AD/HD. In 2011, 11% of parents surveyed were told by a healthcare provider that their child qualified for the diagnosis of AD/HD. However, parents reported that 8.8% of children displayed symptoms of AD/HD, according to parent report. An even smaller amount, 6.1%, were taking medication for AD/HD. The numbers in Florida are quite similar to those of the national average. In fact, Florida ranks 31st highest in the number of children being treated with medication.

So how should a parent determine if their child’s school adjustment problems may be indicative of AD/HD? Unfortunately, that answer may vary based upon which medical professional the parent consults. Some parents report that a prescription for a stimulant medication was written after a consultation only. Many physicians rely upon standardized behavior rating scales completed by parents, and sometimes, by teachers. However, these rating scales simply describe symptoms of AD/HD, which could also be caused by life stressors and other emotional difficulties, such as anxiety or depression.

At Family Psychology Associates, we do not recommend a consultation with a physician without a comprehensive evaluation that not only examines the symptoms of AD/HD, but also looks for the conditions that often coexist with AD/HD. What is really complicating is that some of the coexisting conditions can actually mimic AD/HD. For example, a teen with undiagnosed bipolar disorder who is having their first manic episode may appear to have a sudden onset of AD/HD.

So what constitutes a comprehensive evaluation? The process begins with a history, interview of the child and parents, and the completion of behavior rating scales from home, school and student. This is where most medical exams stop, but we go much further. We obtain an IQ measure to determine the child’s learning potential. We then conduct an academic screening to make sure that the child does not have a learning disability in the areas of reading, mathematics and written language. For young children, we may do a language screening as well. All children complete a test of their ability to copy complex shapes, which may identify children with difficulty displaying what they know on paper. Every student also completes a computerized measure of their sustained attention and impulse control, two of the primary symptoms of AD/HD. This computerized test can be repeated to measure the benefits of treatment. We also obtain estimates of the student’s executive functions, which are the self-control and self-monitoring aspects of the frontal lobes of the brain. Additional measures of anxiety, depression or other emotional problems are administered on a case by case basis.

Ultimately, the most important question for parents is, “so how can you help my child?” This is where the team of professionals at Family Psychology Associates is distinctly different. Our evaluation report may open the door for services in the school, such as an Individualized Educational Plan or a 504 Plan. We can also attend meetings at the school where those plans may be considered. We offer family education for the child, parents and siblings. Parents who need help with their child’s defiant behavior or parents who want to improve parent-teen communication can attend 6 session workshops. Children and teens with social skills deficits can participate in weekly group therapy. To address deficits in executive functions, we have a parent’s seminar and coaching for students via the internet. Students who have problems with working memory, one of the most common aspects of AD/HD, can participate in CogMed, the most well-researched form of neurobiofeedback.

For readings on AD/HD, please visit our AD/HD page under the “Specialities” tab on our website. For questions about our services for AD/HD, use our “Contact Us” page.